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Saturday, April 28, 2007

Health as a Human Right: Lifting Dalits out of Deprivation

In India, Dalits bear disproportionate degrees of premature death and illness by virtue of their destitute living conditions. Dalits are individuals who comprise the lowest rung in the Hindu caste system. Inequitable distributions of income and wealth conscript Dalits into poverty and illness. The health and wellness for Dalits can be best pursued through a human rights framework. Only the rights paradigm can attract enough civil society organizations to marshal in meaningful change.

Caste System 101

A caste system is a society that is stratified along the lines of status, class, and party. One’s caste is inherited at birth, caste determines one’s level of purity or impurity, and individuals are encouraged to marry within their own caste group. Caste ideology is endowed as sacred and, as such, assumes the status quo (Gerth & Mills, 1958). The Hindu caste system divides society into four occupational groups that range from priesthood to manual labour. The most marginalized individuals are the Dalits who are considered outcastes; socially and economically confined to working as servants, sweepers, and manual scavengers.

Caste societies produce marked inequalities in health, with Dalits assuming the greatest degrees of mortality and morbidity. Infant mortality, for instance, is significantly greater among the bottom 20% of income-earners in India compared with the top 20% of income-earners (Subramanian et al., 2006).

Ambedkar’s Legacy

B. R. Ambedkar, a former Dalit scholar and politician, mobilized the Dalit population beyond any other movement in the past. As the chief architect of the Indian Constitution of 1950, Ambedkar instituted affirmative action policies that reserved spots for Dalits in universities and government. However, affirmative policies fail to deliver Dalits with meaningful gains in wealth and, more importantly, in health (Banerjee & Knight, 1985). Income refers to one’s earnings. Wealth refers to one’s assets, such as property and land. In India, “the average size of per capita land owned…by [Dalits] is less than half of that for the [non-Dalit] households” (Kijima, 2006). Consider the wealth divide between those who rent versus those who own their home.

Into The Future

Future social movements must rise above affirmative policies; challenging the social, political, and economic conventions that impede Dalits’ access to the human right of health. Since 1978, at least 6 health promotion declarations from the World Health Organization have embodied values of social justice and peace, and the promotion of health as a human right. The Indian People’s Health Charter specifically declares “health as a justiciable right…demand[ing] the provision of comprehensive health care as a fundamental constitutional right” for the people of India.

Even if income inequalities persist in India, as they will, a basic basket of human and health services should be constitutionally guaranteed to all individuals; healthcare, a living wage, education, and affordable housing. The premature mortality and morbidity rates of Dalits, compared to non-Dalit Indians, extend far beyond the issue of caste: it is an issue of human rights.

Thanks Rahul, I wrote on the Dalits on alive and awake, Joseph D'sousa has been fighting the hypocricy of the church that continue the caste system and has gotten some good response and change as well as threats and poor reception. I believe this is needing everyone to step up and make the right change. His book is Dalit Freedom (by the way)-joe

Hi Pradeep. I am not familiar with evaluations of affirmative/reservation policies, but based on research from the developed world, there remains a stark contrast between income-earners versus wealth-earners. And that is essentially my argument: affirmative policies may reserve spaces in government/universities for Dalits and thereby secure these persons with a better income, but issues of wealth (eg. home ownership, vehicle ownership, stocks/bonds) are not as effectively targeted through affirmative action.

I am interested to read D'Sousa's book Dalit Freedom. Hopefully I will be able to find a copy here in Canada.

I appreciate your tenacity that the Church is hypocritical with respect to the caste system. I believe that the eminence of caste in non-caste religions, such as Christianity, demonstrate that the issue of caste extends well beyond religious tradition (i.e. Hinduism) and permeates societies at the most primal level of culture, norms, and customs.

I can agree with you wholeheartedly that the situation is unfair and needs to be changed, though when I look at it from the perspective of a complete outsider, having no ties to India or its people, I have to ask myself how you would implement a change. Sure, those of us in the west look at this as a violation of human rights, as something outrageous that treats human beings like chattel, but what can we do? Send aid packages? Will they really go to the people who need them? Invade India and declare its people free? Negotiate for the rights of the Dalits with the higher-caste government, perhaps for trade rights or other 'foreign policy' stuffs? Maybe we even could do these things, but we(and I say we, as "countries") wont. There are too many political ramifications, consequences, et cetera.

The people 'on top' don't want equality, they don't want rights for the downtrodden, because it would effect their status as being the biggest fish in the pond. Look at the US Civil war, because people didn't want to give up slaves. Look at medieval times, and people didn't want to give up serfs. We may have come a long way as a global society, but I still don't think we're humanitarian enough for people to look at the less fortunate and say, "let me help you." Some of us, yes. But not enough, not nearly enough.

Though small ripples do make a wave, and I do earnestly hope that this push to give basic human rights, a right to health, to these people could be enough to get people thinking. Small changes that wouldn't upset the entire system, but maybe over time could make a difference.

I really enjoyed the examples that you shared. In both cases of the US Civil War and Midieval times, the atrocities of slavery and serfs were overcome - - after a great struggle and education/enlightenment.

I would not argue that our society has a long way to come in terms of humanitarianism. Such a statement suggests that the global society is progressively shifting away from a state of outright barbarianism. Several societies in the past have upheld social justice (eg. Aboriginals and First Nations cultures). I would instead argue that humankind continues to venture into cycles of selfishness versus justness as different individuals assume positions of power.

I agree with your suggestion that small changes are most effective because they disrupt the system as little as possible. Instead of arguing for a dismantlement of the neoliberal capatlist agenda, I push that free markets continue to operate within the fundamental constraints of human rights defence (eg. the right to health).

Thanks for your thoughts! I really enjoyed reading what you had to say...

Hello Rahul,At the outset, I would like to congratulate you on your scholarship and wish you all the best for your stay at Oxford. I read the article in Yfile and found a link to your blog in it.

I'm an International student at York, from India, so the ethnic/cultural and religious part of my identity was not introduced to me in quite the same way as you described in your blog. Nevertheless, it was quite disconcerting, in precisely the same way, as I have never been able to shrug away from the debate of status by birth. However, I would like to mention some observations which made me think that the disparity in income and wealth that you mention is due to more reasons than caste or creed: in fact the Indian citizen has not yet had access to the benefits of its growing economy, mainly due to insufficient stress on efficient public policy.

Urban/ rural segregation has a big impact on what resources are available to the citizens no matter what caste/creed they come from. You wont find more Dalits or religious minorities in Rural India than in Urban India. The free market/ capitalist nature of growth is more responsible for that than any religious segregation. I get the feeling that you might be a promoter of free markets but I believe that it has failed dismally in India as far as the rise in standard of living of the average Indian is concerned. In fact, almost all of the rural growth that you will find will be due to government aid/ intervention/ subsidies, tax cuts and loan aids that they use to lure business venturers towards Rural India. Not that all urban dwellers have access to the much larger resources and opportunities: you'll find a slum in the backyard of a skyscraper whose dwellers will pay the municipality to demolish the slum so they can have a better view from their balconies. The slum dwellers are more likely than not the general migrating labor force of India, some of whom might be working in the factories owned by the 'gods' living in the 'towers of babel'. Also they are more likely than not, belonging to every religious, ethnic/cultural and caste group you can find in the country.

literacy level rates that are catalouged cannot possibly explain the massive difference in the quality of education, even amongst the so-called literate. If you were merely to look at public schools funded by the government,where the 'rich' kids will never go, there are some schools with a higher drop-out rate than others and those shockingly few who finish high school may never go on to college. This is not unlike the disparity in quality of education that you will find in schools under the Toronto district school board. Just like a school in Richmond Hill is shockingly different from that in North York, what you will find is that those Indian schools with high drop out rates do happen to have students living in the slums, government subsidized housing and cheap rental buildings. These neighborhoods are not any more segregationist than the ones in GTA.

Last but not the least, the general trends in the economy when it comes to investments is another factor that influences the income and wealth disparity in India(Note: I use the two terms together even though I understood the distinction between income and wealth, you were quite clear on it). For example, people in India still prefer to invest in gold, something that is considered a sign of wealth and status by all South Asian cultures, but is not as traceable as the ones you mentioned in your article. This has nothing to do with income and wealth access but more to do with the level of how culturally ingrained an individual is. My grandfather who lost everything in the partition worked hard to educate and provide for his children and then his grandchildren, for the purpose of which he became a smart, versatile, investor but my grandmother simply refuses to refrain from buying a bit of gold every time the prices plummet. I intend to die a spinster out of fear of being crushed in what will probably become my dowry (Dowry is something that i don't want to rant about here). Gold is a long standing traditional form of investment that is still surprising prevalent amongst the most literate, well-to-do families even more so in the not so literate, struggling to make a living ones.

I am a firm believer in affirmative rights activation but i also firmly believe that it is impossible to help any one group of people in a growing economy without trying to improve the standard of living of the nation as a whole. We cannot simply allot more funding for a specific cause while deciding on the national budget. If that tactic was efficient, the Indian standard of living would mirror the exponential growth of the country's economy. As Amartya Sen said on the eve of India's independence day this year, we need an increase in public funding in the avenues of health, education and infrastructure which will help every Indian citizen and therefore the marginalized groups as well.

I seen to have droned on and on and taken up quite some space. Hope you don't mind. All the best,Ekta.